ENDOCRINE - Pituitary Gland, Thyroid, Adrenal Gland Disorders

1. Hyperpituitarism (Growth Hormone Excess)

2. Hypopituitarism (Growth Hormone Deficit)

Anterior Pituitary Gland Disorders

1. Gigantism

2. Acromegaly

Clinical conditions of hyperpituitarism

Gigantism/Giantism

Occurs before the closure of the epiphysis of the long bone

Before the closure of the long bone

When does gigantism ocur

Early childhood/puberty

Onset of gigantism

Proportional

Excessive growth in giantism is ____

1 - 8 ft

2 - 300 lbs

Children can grow as tall as (1) and weigh over (2)

Giantism

Which disease in which children are usually not healthy and die at a young age?

Acromegaly

Occurs slowly at 3rd, 4th, 5th decade of life

1 - SLOWLY

2 - 3rd, 4th, 5th

Acromegaly occurs (1) at (2) decade of life

1. Enlargement of hands & feet

2. Deformity of spine & mandible

3. Coarse facial features

4. Abdominal distention

5. Diaphoresis

6. Oily skin

Physical features of acromegaly

1. Thickening of cheeks

2. Widened nose opening

3. Thickened lips

4. Absence of neck

Coarse facial features include

Hypopituitarism

Decrease in one or more of APG hormone

1 - nonspecific

2 - weakness, fatigue, HA, diminished tolerance to stress, poor resistance to infection

Symptoms of hypopituitarism are (1) and include (2)

Menstrual irregularities, diminished libido, changes in secondary characteristics (decreased breast size).

In women, hypopituitarism could manifest as

Testicular atrophy, loss of libido, impotence, decreased muscle mass

In men, hypopituitarism could manifest as

Replacement of hormones including corticosteroids, thyroid hormones, sex hormones

Management for hypopituitarism

Dwarfism

Failure to grow

1 - slow

2 - proportional

Dwarfism is (1) but (2) growth

1. Hyperthyroidism

2. Hypothyroidism

Thyroid gland disorders

Located in anterior portion of neck in front of the trachea with 2 encapsulated lateral lobes connected by a narrow isthmus; A HIGHLY VASCULARIZED ORGAN

Structure and function of thyroid gland

Thyroid

Drawing ya

T3, T4, Thyrocalcitonin

Thyroid gland secretes

T3 (triodothyronine) and T4 (tetrathyroxine)

T3 and T4 means

1 - T4

2 - T3

(1) is the precursor of (2)

T3

The more active hormone

Iodine

Is necessary for the synthesis/production of thyroid hormones

Seashells and seaweed

Iodine rich food include

Thyroid hormones

(1) directly related to intellectual functioning

Hyperthyroidism

Excessive circulating levels of T3, T4, or both

T3 & T4.

Hormones related to hyperthyroidism

ADULT onset, 30-40 years old

Onset of hyperthyroidism and their age

1. Graves Disease

2. Multinodular goiter

3. Exophthalmus/Exophthalmus

Clinical conditions associated with hyperthyroidism

Small, discrete, autonomously functioning nodules that is secreting thyroid hormones

Explain multinodular goiter

Benign or malignant

Nodules may be

Multisystem, autoimmune syndrome marked by increased thyroid hormone

Explain graves' disease

Insufficient iodine supply

Precipitating factors of graves' disease

Excessive iodine supply

Precipitating factors of multinodular goiter

Eyeballs protrude from the orbit

Explain how exophthalmus works

Upper lids are retracted

Eyeballs are forced outward

Sclera is visible - characteristic stare and protrusion

Signs and symptoms of exophthalmus

Hypofunction of the thyroid gland, lower thyroid secretion, slowing of metabolic process

Explain hypothyroidism

1. Cretinism (children)

2. Myxedema (adults)

Clinical conditions of hypothyroidism

Slow mental and intellectual functioning

Explain cretinism

Thickening of face muscle (moon face)

Eyeballs are thickened

Cheek are thickened

Nose is widened

Lips is thickened

Characteristics of myxedema

Hyper - irritability, agitation, hyperactive movements, tremors, heavy sweating, insomnia

Hypo - fatigue, lethargy, slow clumsy movements

HYPERTHYROIDISM VS HYPOTHYROIDISM ASSESMENT

1. MS

Hyper - increased appetite and peristaltic activity, hyperactive bowel sounds, loose bowel movements BUT noted weight loss

Hypo - decreased appetite and peristaltic activity, hypoactive bowel sounds, dry, hard stools BUT noted weight gain

HYPERTHYROIDISM VS HYPOTHYROIDISM ASSESMENT

1. GIT

Hyper - palpitations, intolerance to heat, tachycardia, increased BP, CARDIAC ARREST

Hypo - slow thready pulse, intolerance to cold, bradycardia, decreased BP, CARDIAC ARREST

HYPERTHYROIDISM VS HYPOTHYROIDISM ASSESMENT

1. CVS

Hyperthyroid crisis (Thyroid Storm/Thyrotoxicosis)

Hyperthyroidism could lead to

Myxedema coma

Hypothyroidism could lead to

1. Serum TSH (T3,T4,) aka Thyroid Panel

2. Radioactive iodine uptake (RAI)

3. Thyroid scan/Thyroid scintigraphy

Diagnostic assessments

1. Anti-thyroid drugs

2. Radioactive I-131 therapy

3. Thyroidectomy

Management of Hyperthyroidism (DRUGS)

Propylthiouracil (PTU)

Methimazole (Tapazole).

Anti-thyroid drugs include

Blocks synthesis of thyroid hormones

MOA of anti-thyroid drugs

1. Thyroid hormones

Management of hypothyroidism

1. LevothyroXINE (Synthyroid) - T4

2. Thyroglobulin (Proloid)

3. Dessicated thyroid (cytomel)

Thyroid hormones for drug therapy are

Newborn screening

Done to newborns to diagnose hypothyroidism

Hypothyroidism is the most commonly diagnosed

Why must newborn screening be done to newborns in relation to the thyroid

Thyroidectomy

Removal of the thyroid glands

1. Complete/Total thyroidectomy

2. Partial/left-right lobe thyroidectomy

Kinds of thyroidectomy

1. Complete cardiac status review

2. Give anti thyroid meds 5-7 days prior to surgery

3. Administer with iodine prep

PRE OP FOR THYROIDECTOMY

EKG, cardiac isoenzymes, 24 hr. Holter monitoring

Cardiac status review includes

Because these patients are at risk for a cardiac arrest

Why do a cardiac status review?

5-7 days

Anti-thyroid meds must be given how many days PTO?

Lugolis solution - 15 cc PO BID x 3 days

What iodine prep is given to pre-op thyroidectomy + dosage

Reduce the size of the thyroid and vascularity (to prevent hemorrhage)

Why give lugolis solution?

1. Check dressing behind the neck

2. Observe for respiratory distress

3. Observe signs of tetany

4. Absence of thyroid storm

5. Relieve the discomfort of sore throat

6. Check for voice-laryngeal nerve damage

POST OP FOR THYROIDECTOMY (very important, comes out in boards)

Patient is supine, tendency is discharges will seep to the back

Why check dressing behind the neck?

1. WHITE piece of cloth @ head of the bed

To prep at bedside for dressing

Could be s/o trauma, edema, hemorrhage

Why observe for respiratory distress?

O2 set up, suction machine, tracheostomy set

Prepare @ bedside for respiratory distress

Attach to ventilator

What to do after putting a tracheostomy?

Spasms, tremors, seizures

Signs of tetany include

Calcium gluconate in tubex (IVTT) in case of emergency

Prepare @ bedside for tetany

Increase temp, pr, bp

Thyroid storm is positive when pt exhibit s

Anti HPN meds

DOC: calciblock (calcibloc) 10 mg SL start

Cooling blanket

Prep @ bedside for thyroid storm

Encourage oral fluids

Cool mist humidifier

Prep at bedside for sore throat

Report to surgeon

Bedside care when you notice voice-laryngeal nerve damage

Enlargement of the thyroid gland not caused by inflammation or neoplasm

Explain simple goiter

Endemic

Type of simple goiter caused by nutritional iodine deficiency

Sporadic

Type of simple goiter caused by ingestion of large amounts of goitrogenic foods

Cabbage, soybeans, peanuts, peaches, peas, strawberries, spinach, radish

Kinds of goitrogenic foods

Sporadic - large intake of seafood and seaweed

What kind of goiter would people living in coastal areas get and why?

Endemic — less intake of seafood and seaweed

What kind of goiter would people living in mountain areas get and why?

Inflammatory process in the thyroid where thyroid tissue is replaced by fibrous tissue

Explain thyroiditis

Hard upon palpation

If thyroid tissue is replaced by fibrous tissue, what do you see upon assessment?

autoimmune disease

Thyroiditis is a kind of?

Stress

Thyroiditis as an AID is aggravated by?

Hashimoto's thyroiditis

Another name for thyroiditis

Located in the upper pole of each kidney

Location of the adrenal glands

90%

How many percent of the gland is the cortex?

50+ hormones

Adrenal glands secrete about how many hormones?

Glucocorticoids (GCC)

Mineralocorticoids (MCC)

Sex hormones

Some hormones secreted by the adrenal glands include

1. Cushing Syndrome

Adrenal gland disorders

Spectrum of clinical abnormalities caused by excess of GCC

Explain cushing syndrome

Excess of GCC

2 - CORTICOSTEROIDS

Cushing syndrome is caused by (1) particularly by (2)

Women

Cushing syndrome/excess use of corticosteroids is more common in

Iatrogenic

Result of a medical treatment (DT prolonged use of steroids)

Cortisone, hydrocortisone, dexamethasone, prednisone, betamethasone

Corticosteroid treatment common preparations (DRUGS)

Oral/tablet

Solution/liquid

Eyedrop

Injectables

Cream, lotion, ointment

Inhalation

Corticosteroid treatment common preparations

Anti inflammatory agents

- inflammation, allergic, immunoreactive, edematous, skin problems, malignancies, degenerative, chronic conditions

Therapeutic effects/ INDICATIONS of corticosteroid treatment